Adult to adult living donor liver transplantation cohor*

描述(由申请人提供)：活体供体肝移植已经迅速被接受为选定的终末期肝病患者的一种治疗选择。在过去的5年里，LDLT从每年大约50-60例增加到今年的近500例，占美国所有肝脏移植手术的近10%。虽然小系列患者的报告表明，LDLT在技术上可以相对较少地出现问题，但目前还没有对照研究评估这种手术与身体移植相比的疗效。由于LDLT对肝移植有潜在的影响，因此有必要对其进行仔细的评估。LDLT队列研究是一项多中心对照研究，旨在衡量LDLT捐赠者和接受者的结局。LDLT队列研究将解决几个重要问题。首先，将与身体移植相比，直接比较接受LDLT的受者的存活率。由于LDLT受体的选择不同于身体移植，因此必须仔细选择本研究的对照组。其次，LDLT可能通过减少移植前的等待时间而潜在地降低等待名单上的死亡率。此外，有初步数据表明，与身体移植受者相比，患有丙型肝炎(这是最常见的LDLT适应症)的LDLT受者的预后可能更差。必须评估LDLT对捐赠者的影响。根据定义，活体捐赠者是一个健康的人，他接受了一次大的腹部手术，但没有个人利益。目前，关于这种供体手术对供体生存和生活质量的影响的数据非常少。因此，确定供者死亡率和与LDLT相关的发病率是当务之急。最后，LDLT队列研究提供了一个直接评估身体移植LDLT总成本的机会。随着LDLT队列研究的完成，医学界将更清楚地了解这一重要程序对肝移植、LDLT接受者和LDLT捐赠者的影响。

DESCRIPTION (provided by applicant): Living donor liver transplantation has rapidly gained acceptance as a treatment option for selected patients with end-stage liver disease. Over the past 5 years, LDLT has grown from approximately 50 - 60 cases per year to nearly 500 cases this year, accounting for nearly 10 % of all liver transplants performed in the United States. While reports of small series of patients have demonstrated that LDLT can be technically performed with relatively few problems, there have been no controlled studies evaluating the efficacy of this procedure compared to cadaveric transplantation. A careful evaluation of LDLT is necessary because of the potential impact of this procedure on liver transplantation. The LDLT Cohort Study is a multi-center controlled study designed to measure the outcomes of donors and recipients of LDLT. There are several important issues which the LDLT Cohort Study will address. First, a direct comparison of survival of recipients of LDLT compared to cadaveric transplantation will be made. Since selection of the LDLT recipient is different than cadaveric transplantation, the control group for this study must be carefully chosen. Second, LDLT may potentially reduce waiting list mortality by reducing waiting time prior to transplantation. In addition, there is preliminary data which suggests that LDLT recipients with hepatitis C (which is the most common indication for LDLT) may have a worse outcome compared to their cadaveric counterparts. The impact of LDLT on the donor must be evaluated. The live donor is by definition a healthy individual who undergoes a major abdominal surgery for no personal benefit. There currently are very little data on the impact of this donor surgery on the donor's survival and quality of life. Therefore, it is imperative to determine donor mortality and morbidity rates associated with LDLT. Finally, the LDLT Cohort Study provides an opportunity to directly the total cost of LDLT with cadaveric transplantation. With completion of the LDLT Cohort Study, the medical community will have a much clearer understanding of the impact of this important procedure on liver transplantation, LDLT recipients and LDLT donors.